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Park JW, Wilson-Barthes MG, Dulin AJ, Hogan JW, Mugavero MJ, Napravnik S, Carey MP, Fava JL, Dale SK, Earnshaw VA, Johnson B, Dougherty-Sheff S, Agil D, Howe CJ. Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States. J Racial Ethn Health Disparities 2024; 11:313-325. [PMID: 37043167 PMCID: PMC10092932 DOI: 10.1007/s40615-023-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To assess overall and by neighborhood risk environments whether multilevel resilience resources were associated with HIV virologic suppression among African American/Black adults in the Southeastern United States. SETTING AND METHODS This clinical cohort sub-study included 436 African American/Black participants enrolled in two parent HIV clinical cohorts. Resilience was assessed using the Multilevel Resilience Resource Measure (MRM) for African American/Black adults living with HIV, where endorsement of a MRM statement indicated agreement that a resilience resource helped a participant continue HIV care despite challenges or was present in a participant's neighborhood. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) for virologic suppression as a function of categorical MRM scores, controlling for demographic, clinical, and behavioral characteristics at or prior to sub-study enrollment. We assessed for effect measure modification (EMM) by neighborhood risk environments. RESULTS Compared to participants with lesser endorsement of multilevel resilience resources, aPRs for virologic suppression among those with greater or moderate endorsement were 1.03 (95% confidence interval: 0.96-1.11) and 1.03 (0.96-1.11), respectively. Regarding multilevel resilience resource endorsement, there was no strong evidence for EMM by levels of neighborhood risk environments. CONCLUSIONS Modest positive associations between higher multilevel resilience resource endorsement and virologic suppression were at times most compatible with the data. However, null findings were also compatible. There was no strong evidence for EMM concerning multilevel resilience resource endorsement, which could have been due to random error. Prospective studies assessing EMM by levels of the neighborhood risk environment with larger sample sizes are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Marta G Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
| | - Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joseph W Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA.
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Park JW, Dulin AJ, Scarpaci MM, Dionne LA, Needham BL, Sims M, Kanaya AM, Kandula NR, Loucks EB, Fava JL, Eaton CB, Howe CJ. Examining the Relationship Between Multilevel Resilience Resources and Cardiovascular Disease Incidence, Overall and by Psychosocial Risks, Among Participants in the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. Am J Epidemiol 2023; 192:1864-1881. [PMID: 37442807 PMCID: PMC11043787 DOI: 10.1093/aje/kwad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/20/2022] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
We examined relationships between resilience resources (optimism, social support, and neighborhood social cohesion) and cardiovascular disease (CVD) incidence and assessed potential effect-measure modification by psychosocial risk factors (e.g., stress, depression) among adults without CVD in 3 cohort studies (2000-2018): the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. We fitted adjusted Cox models accounting for within-neighborhood clustering while censoring at dropout or non-CVD death. We assessed for effect-measure modification by psychosocial risks. In secondary analyses, we estimated standardized risk ratios using inverse-probability-weighted Aalen-Johansen estimators to account for confounding, dropout, and competing risks (non-CVD deaths) and obtained 95% confidence intervals (CIs) using cluster bootstrapping. For high and medium (versus low) optimism (n = 6,243), adjusted hazard ratios (HRs) for incident CVD were 0.94 (95% CI: 0.78, 1.13) and 0.90 (95% CI: 0.75, 1.07), respectively. Corresponding HRs were 0.88 (95% CI: 0.74, 1.04) and 0.92 (95% CI: 0.79, 1.06) for social support (n = 7,729) and 1.10 (95% CI: 0.94, 1.29) and 0.99 (95% CI: 0.85, 1.16) for social cohesion (n = 7,557), respectively. Some psychosocial risks modified CVD HRs. Secondary analyses yielded similar findings. For optimism and social support, an inverse relationship was frequently most compatible with the data, but a positive relationship was also compatible. For neighborhood social cohesion, positive and null relationships were most compatible. Thus, specific resilience resources may be potential intervention targets, especially among certain subgroups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Chanelle J Howe
- Correspondence to Dr. Chanelle Howe, Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, Providence, RI 02912 (e-mail: )
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Park JW, Howe CJ, Dionne LA, Scarpaci MM, Needham BL, Sims M, Kanaya AM, Kandula NR, Fava JL, Loucks EB, Eaton CB, Dulin AJ. Social support, psychosocial risks, and cardiovascular health: Using harmonized data from the Jackson Heart Study, Mediators of Atherosclerosis in South Asians Living in America Study, and Multi-Ethnic Study of Atherosclerosis. SSM Popul Health 2022; 20:101284. [PMID: 36387018 PMCID: PMC9646650 DOI: 10.1016/j.ssmph.2022.101284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Social support may have benefits on cardiovascular health (CVH). CVH is evaluated using seven important metrics (Life's Simple 7; LS7) established by the American Heart Association (e.g., smoking, diet). However, evidence from longitudinal studies is limited and inconsistent. The objective of this study is to examine the longitudinal relationship between social support and CVH, and assess whether psychosocial risks (e.g., anger and stress) modify the relationship in a racially/ethnically diverse population. Methods Participants from three harmonized cohort studies - Jackson Heart Study, Mediators of Atherosclerosis in South Asians Living in America, and Multi-Ethnic Study of Atherosclerosis - were included. Repeated-measures modified Poisson regression models were used to examine the overall relationship between social support (in tertiles) and CVH (LS7 metric), and to assess for effect modification by psychosocial risk. Results Among 7724 participants, those with high (versus low) social support had an adjusted prevalence ratio (aPR) and 95% confidence interval (CI) for ideal or intermediate (versus poor) CVH of 0.99 (0.96-1.03). For medium (versus low) social support, the aPR (95% CI) was 1.01 (0.98-1.05). There was evidence for modification by employment and anger. Those with medium (versus low) social support had an aPR (95% CI) of 1.04 (0.99-1.10) among unemployed or low anger participants. Corresponding results for employed or high anger participants were 0.99 (0.94-1.03) and 0.97 (0.91-1.03), respectively. Conclusion Overall, we observed no strong evidence for an association between social support and CVH. However, some psychosocial risks may be modifiers. Prospective studies are needed to assess the social support-CVH relationship by psychosocial risks in racially/ethnically diverse populations.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Chanelle J. Howe
- Center for Epidemiologic Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Laura A. Dionne
- Center for Health Promotion and Health Equity Research, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Matthew M. Scarpaci
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | | | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Joseph L. Fava
- Center for Health Promotion and Health Equity Research, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Eric B. Loucks
- Department of Epidemiology, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity Research, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Charles B. Eaton
- Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Akilah J. Dulin
- Center for Epidemiologic Research, Brown University, Providence, RI, USA
- Center for Health Promotion and Health Equity Research, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
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Dulin AJ, Park JW, Scarpaci MM, Dionne LA, Sims M, Needham BL, Fava JL, Eaton CB, Kanaya AM, Kandula NR, Loucks EB, Howe CJ. Examining relationships between perceived neighborhood social cohesion and ideal cardiovascular health and whether psychosocial stressors modify observed relationships among JHS, MESA, and MASALA participants. BMC Public Health 2022; 22:1890. [PMID: 36221065 PMCID: PMC9552445 DOI: 10.1186/s12889-022-14270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Psychosocial stressors increase the risks for cardiovascular disease across diverse populations. However, neighborhood level resilience resources may protect against poor cardiovascular health (CVH). This study used data from three CVH cohorts to examine longitudinally the associations of a resilience resource, perceived neighborhood social cohesion (hereafter referred to as neighborhood social cohesion), with the American Heart Association's Life's Simple 7 (LS7), and whether psychosocial stressors modify observed relationships. METHODS We examined neighborhood social cohesion (measured in tertiles) and LS7 in the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, and Mediators of Atherosclerosis in South Asians Living in America study. We used repeated-measures, modified Poisson regression models to estimate the relationship between neighborhood social cohesion and LS7 (primary analysis, n = 6,086) and four biological metrics (body mass index, blood pressure, cholesterol, blood glucose; secondary analysis, n = 7,291). We assessed effect measure modification by each psychosocial stressor (e.g., low educational attainment, discrimination). RESULTS In primary analyses, adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for ideal/intermediate versus poor CVH among high or medium (versus low) neighborhood social cohesion were 1.01 (0.97-1.05) and 1.02 (0.98-1.06), respectively. The psychosocial stressors, low education and discrimination, functioned as effect modifiers. Secondary analyses showed similar findings. Also, in the secondary analyses, there was evidence for effect modification by income. CONCLUSION We did not find much support for an association between neighborhood social cohesion and LS7, but did find evidence of effect modification. Some of the effect modification results operated in unexpected directions. Future studies should examine neighborhood social cohesion more comprehensively and assess for effect modification by psychosocial stressors.
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Affiliation(s)
- Akilah J Dulin
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Box G-S121-8, 02912, Providence, RI, USA.
| | - Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Matthew M Scarpaci
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island, USA
| | - Laura A Dionne
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Mario Sims
- Department of Social Medicine, Population and Public Health, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Belinda L Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Charles B Eaton
- Center for Epidemiologic Research, Department of Epidemiology, Brown University, Providence, RI, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Primary Care and Prevention Kent Memorial Hospital, Warwick, RI, USA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Namratha R Kandula
- Department of Internal Medicine, Northwestern University, Chicago, IL, USA
| | - Eric B Loucks
- Center for Epidemiologic Research, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, Brown University, Providence, RI, USA
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LaRose JG, Leahey TM, Lanoye A, Bean MK, Fava JL, Tate DF, Evans RK, Wickham EP, Henderson MM. Effect of a Lifestyle Intervention on Cardiometabolic Health Among Emerging Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231903. [PMID: 36121656 PMCID: PMC9486452 DOI: 10.1001/jamanetworkopen.2022.31903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE The prevalence of obesity has increased substantially among emerging adults, yet no previous large-scale behavioral weight loss trials have been conducted among this age group. OBJECTIVE To test the effect of 2 theory-based motivational enhancements on weight loss within a primarily digital lifestyle intervention designed for emerging adults. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at an academic medical research center, 382 participants aged 18 to 25 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45 were enrolled between February 2, 2016, and February 6, 2019. Data collection was completed February 8, 2020. Analysis was performed on an intention-to-treat basis. INTERVENTIONS Participants were randomized to 1 of 3 groups: developmentally adapted behavioral weight loss (aBWL), aBWL plus behavioral economics (aBWL + BE), or aBWL plus self-determination theory (aBWL + SDT). All groups received a 6-month intervention with 1 group session, 1 individual session, and a digital platform (digital tools for self-monitoring, weekly lessons, tailored feedback, text messages, and optional social media). The aBWL + BE group received modest financial incentives for self-monitoring and weight loss; the aBWL + SDT group received optional experiential classes. Coaching and message framing varied by group. MAIN OUTCOMES AND MEASURES The primary outcome was mean (SE) weight change (in kilograms) at 6 months. Secondary outcomes included proportion of participants achieving weight loss of 5% or more, percentage weight change, waist circumference, body composition, and blood pressure. RESULTS Among the 382 participants (mean [SD] age, 21.9 [2.2] years), 316 (82.7%) were female, mean (SD) BMI was 33.5 (4.9), 222 (58.1%) were of underrepresented race and/or ethnicity, and 320 (83.8%) were retained at the primary end point. There was a significant time effect for mean (SE) weight loss (-3.22 [0.55] kg in the aBWL group; -3.47 [0.55] kg in the aBWL + BE group; and -3.40 [0.53] kg in the aBWL + SDT group; all P < .001), but no between-group differences were observed (aBWL vs aBWL + BE: difference, -0.25 kg [95% CI, -1.79 to 1.29 kg]; P = .75; aBWL vs aBWL + SDT: difference, -0.18 kg [95% CI, -1.67 to 1.31 kg]; P = .81; and aBWL + SDT vs aBWL + BE: difference, 0.07 kg [95% CI, -1.45 to 1.59 kg]; P = .93). The proportion of participants achieving a weight loss of 5% or more was 40.0% in the aBWL group (50 of 125), 39.8% in the aBWL + BE group (51 of 128), and 44.2% in the aBWL + SDT group (57 of 129), which was not statistically different across groups (aBWL vs aBWL + BE, P = .89; aBWL vs aBWL + SDT, P = .45; aBWL + SDT vs aBWL + BE, P = .54). Parallel findings were observed for all secondary outcomes-clinically and statistically significant improvements with no differences between groups. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, all interventions produced clinically significant benefit, but neither of the motivational enhancements promoted greater reductions in adiposity compared with the developmentally adapted standard group. Continued efforts are needed to optimize lifestyle interventions for this high-risk population and determine which intervention works best for specific individuals based on sociodemographic and/or psychosocial characteristics. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02736981.
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Affiliation(s)
- Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond
| | - Tricia M. Leahey
- Department of Allied Health Sciences, University of Connecticut, Storrs
| | - Autumn Lanoye
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond
- Massey Cancer Center, Virginia Commonwealth University, Richmond
| | - Melanie K. Bean
- Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond
| | - Joseph L. Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Deborah F. Tate
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ronald K. Evans
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond
| | - Edmond P. Wickham
- Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond
| | - Megan M. Henderson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond
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Dulin AJ, Fava JL, Earnshaw VA, Dale SK, Carey MP, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Agil D, Howe CJ. Development of Long and Short Forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. AIDS Behav 2022; 26:2469-2484. [PMID: 35092536 PMCID: PMC10782857 DOI: 10.1007/s10461-022-03579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 01/15/2023]
Abstract
Understanding resilience in relation to HIV-related outcomes may help address racial/ethnic disparities, however, significant gaps in its measurement preclude in-depth study. Thus, this research aims to develop and evaluate the psychometric properties of long and short forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. To develop the items, we conducted a mixed methods study (N = 48) and reviewed published resilience measures. We completed content validity index analyses to ensure the items reflected the resilience construct. Next, we conducted 20 cognitive interviews and a field survey (N = 400). The long and short forms demonstrated acceptable to excellent psychometric properties based on factorial validity, internal consistency and convergent validity and on measurement invariance (conducted for the short form only). These measures provide a comprehensive framework to examine resilience and HIV-related outcomes and can inform resilience-building interventions to reduce racial and ethnic health disparities.
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Affiliation(s)
- Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Marta Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Park JW, Dulin AJ, Needham BL, Sims M, Loucks EB, Fava JL, Dionne LA, Scarpaci MM, Eaton CB, Howe CJ. Examining Optimism, Psychosocial Risks, and Cardiovascular Health Using Life's Simple 7 Metrics in the Multi-Ethnic Study of Atherosclerosis and the Jackson Heart Study. Front Cardiovasc Med 2021; 8:788194. [PMID: 34977194 PMCID: PMC8714850 DOI: 10.3389/fcvm.2021.788194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Optimism has been shown to be positively associated with better cardiovascular health (CVH). However, there is a dearth of prospective studies showing the benefits of optimism on CVH, especially in the presence of adversities, i.e., psychosocial risks. This study examines the prospective relationship between optimism and CVH outcomes based on the Life's Simple 7 (LS7) metrics and whether multilevel psychosocial risks modify the aforementioned relationship. Methods: We examined self-reported optimism and CVH using harmonized data from two U.S. cohorts: Multi-Ethnic Study of Atherosclerosis (MESA) and Jackson Heart Study (JHS). Modified Poisson regression models were used to estimate the relationship between optimism and CVH using LS7 among MESA participants (N = 3,520) and to examine the relationship of interest based on four biological LS7 metrics (body mass index, blood pressure, cholesterol, and blood glucose) among JHS and MESA participants (N = 5,541). For all CVH outcomes, we assessed for effect measure modification by psychosocial risk. Results: Among MESA participants, the adjusted risk ratio (aRR) for ideal or intermediate CVH using LS7 comparing participants who reported high or medium optimism to those with the lowest level of optimism was 1.10 [95% Confidence Interval (CI): 1.04-1.16] and 1.05 (95% CI: 0.99-1.11), respectively. Among MESA and JHS participants, the corresponding aRRs for having all ideal or intermediate (vs. no poor) metrics based on the four biological LS7 metrics were 1.05 (0.98-1.12) and 1.04 (0.97-1.11), respectively. The corresponding aRRs for having lower cardiovascular risk (0-1 poor metrics) based on the four biological LS7 metrics were 1.01 (0.98-1.03) and 1.01 (0.98-1.03), respectively. There was some evidence of effect modification by neighborhood deprivation for the LS7 outcome and by chronic stress for the ideal or intermediate (no poor) metrics outcome based on the four biological LS7 metrics. Conclusion: Our findings suggest that greater optimism is positively associated with better CVH based on certain LS7 outcomes among a racially/ethnically diverse study population. This relationship may be effect measure modified by specific psychosocial risks. Optimism shows further promise as a potential area for intervention on CVH. However, additional prospective and intervention studies are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Brown University, Providence, RI, United States
- Department of Epidemiology, Brown University, Providence, RI, United States
| | - Akilah J. Dulin
- Center for Epidemiologic Research, Brown University, Providence, RI, United States
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
| | - Belinda L. Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Eric B. Loucks
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
| | - Joseph L. Fava
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Laura A. Dionne
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity Research, Brown University, Providence, RI, United States
| | - Matthew M. Scarpaci
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, United States
| | - Charles B. Eaton
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Chanelle J. Howe
- Center for Epidemiologic Research, Brown University, Providence, RI, United States
- Department of Epidemiology, Brown University, Providence, RI, United States
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Guthrie KM, Rosen RK, Guillen M, Ramirez JJ, Vargas SE, Fava JL, Ham AS, Katz DF, Cu-Uvin S, Tumilty S, Smith KA, Buckheit KW, Buckheit RW. Designing Dual Compartment HIV Prevention Products: Women's Sensory Perceptions and Experiences of Suppositories for Rectal and Vaginal Use. AIDS Res Hum Retroviruses 2021; 38:601-610. [PMID: 34544269 DOI: 10.1089/aid.2021.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dual compartment suppositories are being developed to prevent HIV and other sexually transmitted infections. Such products, for use in the rectum, the vagina, or both, could have a significant public health impact by decreasing global incidence of these diseases. In this study, 16 women each used two rheologically distinct suppositories in their vagina and rectum. User Sensory Perception and Experience (USPE) scales assessed sensory experiences during sexual activity to understand whether, and how, women perceive formulation properties in the vagina and rectum. Qualitative data from individual in-depth interviews captured women's descriptions and comparisons of the experiences. Significant differences and large Cohen's d effect sizes between vaginal and rectal experiences of suppository-A were found for three scales: Application (APP): Product Awareness, SEX: Initial Penetration; and SEX: Effortful. Qualitative data provided user experience details that credibly align with these score differences. Near significant differences and large effect sizes were found for two additional scales: SEX: Perceived Wetness with suppository-A and SEX: Messiness with suppository-B. In addition, other scale scores showed medium-to-large effect sizes that correspond to hypothesized sensations associated with biophysical properties of the suppositories. Statistical significance combined with large effect sizes and qualitative data accurately represent the hypothesized perceptibility of suppository properties and identifies performance characteristics relevant to acceptability and adherence; together these data provide discernment of factors that can guide the development of dual compartment products. The Clinical Trial Registration number: NCT02744261.
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Affiliation(s)
- Kate M. Guthrie
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Melissa Guillen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Jaime J. Ramirez
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Sara E. Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph L. Fava
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | | | - David F. Katz
- Departments of Bioengineering and Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Susan Cu-Uvin
- Department of Obstetrics and Gynecology and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sheila Tumilty
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kelley A. Smith
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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9
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Park JW, Mealy R, Saldanha IJ, Loucks EB, Needham BL, Sims M, Fava JL, Dulin AJ, Howe CJ. Multilevel resilience resources and cardiovascular disease in the United States: A systematic review and meta-analysis. Health Psychol 2021; 41:278-290. [PMID: 34138614 DOI: 10.1037/hea0001069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: This systematic review and meta-analysis aimed to quantify the relationship between resilience resources at the individual (e.g., optimism), interpersonal (e.g., social support), and neighborhood (e.g., social environment) levels, and cardiovascular outcomes among adults in the United States. Method: On 9/25/2020, electronic databases (PubMed, Embase, CINAHL, PsycINFO) were systematically searched for randomized controlled trials, nonrandomized intervention studies, and prospective cohort studies that examined the relationship between resilience resources at the individual, interpersonal, or neighborhood level and cardiovascular outcomes. Studies that met the eligibility criteria were summarized narratively and quantitatively. Because relevant search results yielded only observational studies, risk of bias was assessed using an adapted version of the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Results: From 4,103 unique records, 13 prospective cohort studies with a total of 310,906 participants met the eligibility criteria, and six of these studies were included in the meta-analyses. Most relevant studies found that higher levels of individual-level resilience resources were associated with lower incidence of adverse cardiovascular outcomes, with point estimates ranging from .46 to 1.18. Interpersonal-level resilience resources (i.e., social network) were associated with a lower coronary heart disease risk (risk ratio, .76; 95% CI [.56, 1.02]). Neighborhood-level resilience resources (i.e., perceived social cohesion and residential stability) were associated with a lower odds of stroke (odds ratio, .92; 95% CI [.84, 1.01]). Conclusions: Evidence suggests that higher levels of resilience resources are associated with better cardiovascular outcomes. However, more prospective studies with diverse populations are needed to strengthen the evidence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Rachel Mealy
- Center for Health Promotion and Health Equity Research
| | | | | | | | | | - Joseph L Fava
- Center for Health Promotion and Health Equity Research
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10
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Harlow LL, Aiken L, Blankson AN, Boodoo GM, Brick LAD, Collins LM, Cumming G, Fava JL, Goodwin MS, Hoeppner BB, Mackinnon DP, Molenaar PCM, Rodgers JL, Rossi JS, Scott A, Steiger JH, West SG. A Tribute to the Mind, Methodology and Mentoring of Wayne Velicer. Multivariate Behav Res 2021; 56:377-389. [PMID: 32077317 PMCID: PMC7438240 DOI: 10.1080/00273171.2020.1729083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Wayne Velicer is remembered for a mind where mathematical concepts and calculations intrigued him, behavioral science beckoned him, and people fascinated him. Born in Green Bay, Wisconsin on March 4, 1944, he was raised on a farm, although early influences extended far beyond that beginning. His Mathematics BS and Psychology minor at Wisconsin State University in Oshkosh, and his PhD in Quantitative Psychology from Purdue led him to a fruitful and far-reaching career. He was honored several times as a high-impact author, was a renowned scholar in quantitative and health psychology, and had more than 300 scholarly publications and 54,000+ citations of his work, advancing the arenas of quantitative methodology and behavioral health. In his methodological work, Velicer sought out ways to measure, synthesize, categorize, and assess people and constructs across behaviors and time, largely through principal components analysis, time series, and cluster analysis. Further, he and several colleagues developed a method called Testing Theory-based Quantitative Predictions, successfully applied to predicting outcomes and effect sizes in smoking cessation, diet behavior, and sun protection, with the potential for wider applications. With $60,000,000 in external funding, Velicer also helped engage a large cadre of students and other colleagues to study methodological models for a myriad of health behaviors in a widely applied Transtheoretical Model of Change. Unwittingly, he has engendered indelible memories and gratitude to all who crossed his path. Although Wayne Velicer left this world on October 15, 2017 after battling an aggressive cancer, he is still very present among us.
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11
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Serber ER, Christon LM, Fava JL, Verrier RL, Nearing BD, Buxton AE, Gold MR, Rodrigue JR, Frisch MB. Positive Psychotherapy Improves Cardiac Electrical Stability and Mood in ICD Patients: PAM-ICD Trial Results. Psychosom Med 2021; 83:300-301. [PMID: 33534391 PMCID: PMC8016718 DOI: 10.1097/psy.0000000000000919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eva R. Serber
- Bio-behavioral Medicine/ Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Lillian M. Christon
- Bio-behavioral Medicine/ Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Joseph L. Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Richard L. Verrier
- Department of Medicine, Cardiovascular Medicine Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Bruce D. Nearing
- Department of Medicine, Cardiovascular Medicine Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alfred E. Buxton
- Department of Medicine, Cardiovascular Medicine Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael R. Gold
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - James R. Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael B. Frisch
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
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12
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Dulin AJ, Earnshaw VA, Dale SK, Carey MP, Fava JL, Wilson-Barthes M, Mugavero MJ, Dougherty-Sheff S, Johnson B, Napravnik S, Howe CJ. A Concept Mapping Study to Understand Multilevel Resilience Resources Among African American/Black Adults Living with HIV in the Southern United States. AIDS Behav 2021; 25:773-786. [PMID: 32940827 DOI: 10.1007/s10461-020-03042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
Resilience may help people living with HIV (PLWH) overcome adversities to disease management. This study identifies multilevel resilience resources among African American/Black (AA/B) PLWH and examines whether resilience resources differ by demographics and neighborhood risk environments. We recruited participants and conducted concept mapping at two clinics in the southeastern United States. Concept Mapping incorporates qualitative and quantitative methods to represent participant-generated concepts via two-dimensional maps. Eligible participants had to attend ≥ 75% of their scheduled clinic appointments and did not have ≥ 2 consecutive detectable HIV-1 viral load measurements in the past 2 years. Of the 85 AA/B PLWH who were invited, forty-eight participated. Twelve resilience resource clusters emerged-five individual, two interpersonal, two organizational/policy and three neighborhood level clusters. There were strong correlations in cluster ratings for demographic and neighborhood risk environment comparison groups (r ≥ 0.89). These findings could inform development of theories, measures and interventions for AA/B PLWH.
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13
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Carroll AJ, Christon LM, Rodrigue JR, Fava JL, Frisch MB, Serber ER. Implementation, feasibility, and acceptability of quality of life therapy to improve positive emotions among patients with implantable cardioverter defibrillators. J Behav Med 2020; 43:968-978. [PMID: 32285238 PMCID: PMC7554076 DOI: 10.1007/s10865-020-00153-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) save lives, but often induce significant psychological distress among patients. Positive psychological constructs are associated with improved outcomes among cardiac patients. In this NHLBI-funded randomized controlled trial, one aim was to evaluate the feasibility and acceptability of a positive psychology intervention (Quality of Life Therapy; QOLT, n = 11), compared to a Heart Healthy Education (HHE) control (n = 10), among ICD patients. A majority of participants across groups attended all 12 sessions (71%) and completed homework assignments (80%). Agreement on participant engagement and interventionist protocol adherence were high, with no differences between groups (ps > 0.20). A greater proportion of QOLT participants rated their sessions was "very" helpful compared to HHE participants (63% vs. 10%, p = 0.19). These initial data support the feasibility and acceptability of QOLT. A larger-scale trial using positive psychology interventions among ICD patients is indicated to determine potential mechanisms underlying the relationship between positive psychological constructs and cardiovascular health.
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Affiliation(s)
- Allison J Carroll
- Division of Bio-Behavioral Medicine, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lillian M Christon
- Division of Bio-Behavioral Medicine, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | | | - Eva R Serber
- Division of Bio-Behavioral Medicine, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.
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14
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Guthrie KM, Fava JL, Vargas SE, Rosen RK, Shaw JG, Kojic EM, Ham AS, Rohan LC, Katz D, Panameño A, Colleran C, Friend DF, Buckheit KW, Buckheit RW. The Role of Volume in the Perceptibility of Topical Vaginal Formulations: User Sensory Perceptions and Experiences of Heterosexual Couples During Vaginal Sex. AIDS Res Hum Retroviruses 2020; 36:1059-1070. [PMID: 32988214 DOI: 10.1089/aid.2020.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Users' sensory perceptions and experiences (USPEs; perceptibility) of drug formulations can critically impact product adoption and adherence, especially when products rely on appropriate user behaviors (timing of administration, dosing measurement) for effectiveness. The use of topical gel formulations for effective antihuman immunodeficiency virus/sexually transmitted infection (HIV/STI) vaginal microbicides has been associated with messiness and other use-associated challenges, resulting in low adherence. Nonetheless, such formulations remain attractive due to good pharmacokinetics and resulting pharmacodynamics through their volume and surface contact for drug delivery into luminal fluids and mucosa. Consequently, advocates and scientists continue to pursue topical forms [semisolid (e.g., gel, suppository); solid (e.g., film)] to deliver select drugs and offer user choice in HIV/STI prevention. The current data build on previously validated USPE scales evaluating perceptibility of gels with various biophysical/rheological properties. Specifically, increased formulation parameter space adds a new set of properties inherent in quick-dissolving film. We compared film, a product adding no discernable volume to the vaginal environment, to 2 and 3.5 mL hydroxyethyl cellulose gel to consider the impact of volume on user experience. We also examined the USPE scales for evaluation of male sexual partners' experiences. The original USPE scales functioned as expected. Additionally, six new USPE scales were identified in this enhanced parameter space. Significant differences were noted between USPEs in pairwise comparisons, with largest differences between film and high-volume gel. Product developers and behavioral scientists can use these scales to design products, optimizing user experience and maximizing adherence and delivery of efficacious anti-HIV/STI pharmaceuticals. They can be extended to evaluation of additional formulations, devices, and compartments, as well as single- and multipurpose pharmaceuticals. In broader contexts, USPEs could be of value in evaluating formulations and devices to prevent/treat other diseases (e.g., ophthalmologic, dermatologic). Steadfast attention should be given to patient experience, and, where applicable, experiences of partners and/or caregivers.
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Affiliation(s)
- Kate M. Guthrie
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joseph L. Fava
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Sara E. Vargas
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rochelle K. Rosen
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Julia G. Shaw
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Erna M. Kojic
- Division of Infectious Disease, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Lisa C. Rohan
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
- Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Katz
- Department of Bioengineering, Duke University, Durham, North Carolina, USA
- Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina, USA
| | - Anacecilia Panameño
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Christopher Colleran
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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15
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Tuttle JR, Fava JL, Edwards TB, Norris TR, Hatzidakis AM, Green A. The relationship of shoulder elevation strength to patient-reported outcome after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2406-2416. [PMID: 32631643 DOI: 10.1016/j.jse.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most patient-reported outcome measures (PROMs) used to assess outcomes after anatomic total shoulder arthroplasty (aTSA) focus on pain and function. Although strength is considered an important component of function, only the Constant-Murley score (CMS) includes an objective measurement of shoulder strength. The purpose of this study was to evaluate the relationship between shoulder elevation strength (SES) and PROMs after aTSA for the treatment of primary glenohumeral osteoarthritis (GHOA). METHODS This was a retrospective analysis of 605 patients enrolled in a multicenter clinical database who underwent aTSA to treat primary GHOA. Patients were evaluated preoperatively and at 24 months after surgery. Outcome was assessed with the CMS, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder score, Single Assessment Numeric Evaluation score, and patient satisfaction. Relationships between SES and outcomes were investigated. RESULTS The correlations between SES and the PROMs before and after treatment were very weak and weak, respectively (r ≤ 0.262 for all). The strength of the correlations between the absolute and adjusted CMS and the other PROMs varied from weak to moderate (r = 0.180 to r = 0.455), and the strength of the correlations was greater postoperatively. With the strength component removed from the CMS, the correlations between the CMS and other PROMs were stronger (r = 0.194 to r = 0.495). CONCLUSIONS Although measurement of SES provides objective information about shoulder function and outcome related to the treatment of primary GHOA with aTSA, the actual relevance to patients is unclear as the correlations between SES and PROMs were weak. Furthermore, the variable correlations between the CMS and PROMs call into question the exclusive use of the CMS and support the use of other PROMs that may more accurately reflect patient perception of outcome.
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Affiliation(s)
- John R Tuttle
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - Tom R Norris
- California Pacific Orthopaedics, San Francisco, CA, USA
| | | | - Andrew Green
- Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
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16
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LaRose JG, Gorin AA, Fava JL, Bean MK, Lanoye A, Robinson E, Carey K. Using motivational interviewing to enhance emerging adults' engagement in weight loss: The Live Well RVA pilot randomized clinical trial. Obes Sci Pract 2020; 6:460-472. [PMID: 33082988 PMCID: PMC7556426 DOI: 10.1002/osp4.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background Emerging adults (ages 18–25) are at high risk for overweight/obesity, yet traditional adult behavioural weight loss (BWL) interventions do not meet the needs of individuals at this developmental stage. Motivational interviewing (MI) is an evidence‐based approach to promote behaviour change but has not been tested for weight loss in this population. The study aimed to test the feasibility and preliminary efficacy of an MI‐enhanced weight loss programme to promote engagement, retention and weight loss in emerging adults. Methods Emerging adults with overweight/obesity (N = 47, 81% female, 47% racial/ethnic minority, body mass index [BMI] = 33.2 ± 4.6 kg/m2) were randomized to either standard BWL or MI‐enhanced BWL (MIBWL). Weight was assessed objectively at baseline and posttreatment (3 months). Engagement (in‐person session attendance [weeks 1 and 2], online self‐monitoring [weeks 3–12] and online content viewing [weeks 3–12]) was tracked throughout the program. Results Though results did not reach the level of statistical significance, participants in MIBWL demonstrated greater programme engagement (77% vs. 61.0%, p = .11; Cohen d = .48), retention (71% vs. 48.0%, p = .10; Cohen h = .47) and intent‐to‐treat weight loss (−3.3% vs. −2.2%, p = .37; Cohen d = .26) compared with those in BWL. Conclusions Effect sizes suggest that MI might be a viable approach to enhance engagement and retention in weight loss programmes targeting emerging adults. This finding is meaningful, given the documented challenges with engagement and retention in this vulnerable population and the relationship between engagement and better weight loss outcomes. The results of this small pilot study support efforts to replicate these findings within the context of a fully powered trial.
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Affiliation(s)
- Jessica Gokee LaRose
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Amy A Gorin
- Department of Psychological Sciences University of Connecticut Mansfield Connecticut USA.,Institute for Collaboration on Health, Intervention, and Policy University of Connecticut Mansfield Connecticut USA
| | - Joseph L Fava
- Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
| | - Melanie K Bean
- Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond Virginia USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Elizabeth Robinson
- Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond Virginia USA.,Summit Emotional Health Richmond Virginia USA
| | - Kate Carey
- Department of Behavioral and Social Sciences Brown University School of Public Health Providence Rhode Island USA
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17
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Bock BC, Dunsiger SI, Rosen RK, Thind H, Jennings E, Fava JL, Becker BM, Carmody J, Marcus BH. Yoga as a Complementary Therapy for Smoking Cessation: Results From BreathEasy, a Randomized Clinical Trial. Nicotine Tob Res 2020; 21:1517-1523. [PMID: 30295912 DOI: 10.1093/ntr/nty212] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION There is evidence that Yoga may be helpful as an aid for smoking cessation. Yoga has been shown to reduce stress and negative mood and may aid weight control, all of which have proven to be barriers to quitting smoking. This study is the first rigorous, randomized clinical trial of Yoga as a complementary therapy for smokers attempting to quit. METHODS Adult smokers (N = 227; 55.5% women) were randomized to an 8-week program of cognitive-behavioral smoking cessation and either twice-weekly Iyengar Yoga or general Wellness classes (control). Assessments included cotinine-verified 7-day point prevalence abstinence at week 8, 3-month, and 6-month follow-ups. RESULTS At baseline, participants' mean age was 46.2 (SD = 12.0) years and smoking rate was 17.3 (SD = 7.6) cigarettes/day. Longitudinally adjusted models of abstinence outcomes demonstrated significant group effects favoring Yoga. Yoga participants had 37% greater odds of achieving abstinence than Wellness participants at the end of treatment (EOT). Lower baseline smoking rates (≤10 cigarettes/day) were also associated with higher likelihood of quitting if given Yoga versus Wellness (OR = 2.43, 95% CI = 1.09% to 6.30%) classes at EOT. A significant dose effect was observed for Yoga (OR = 1.12, 95% CI = 1.09% to 1.26%), but not Wellness, such that each Yoga class attended increased quitting odds at EOT by 12%. Latent Class Modeling revealed a 4-class model of distinct quitting patterns among participants. CONCLUSIONS Yoga appears to increase the odds of successful smoking abstinence, particularly among light smokers. Additional work is needed to identify predictors of quitting patterns and inform adjustments to therapy needed to achieve cessation and prevent relapse. IMPLICATIONS This study adds to our knowledge of the types of physical activity that aid smoking cessation. Yoga increases the odds of successful smoking abstinence, and does so in a dose-response manner. This study also revealed four distinct patterns of smoking behavior among participants relevant to quitting smoking. Additional work is needed to determine whether variables that are predictive of these quitting patterns can be identified, which might suggest modifications to therapy for those who are unable to quit.
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Affiliation(s)
- Beth C Bock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.,Brown School of Public Health, Brown University, Providence, RI.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Shira I Dunsiger
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.,Brown School of Public Health, Brown University, Providence, RI.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Rochelle K Rosen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.,Brown School of Public Health, Brown University, Providence, RI.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Herpreet Thind
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Ernestine Jennings
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.,Brown School of Public Health, Brown University, Providence, RI.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Bruce M Becker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.,Brown School of Public Health, Brown University, Providence, RI.,Rhode Island Hospital, Providence, RI
| | - James Carmody
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Bess H Marcus
- Brown School of Public Health, Brown University, Providence, RI
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18
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Bonnewell J, Magaziner S, Fava JL, Montgomery MC, Almonte A, Carey M, Chan PA. A survey of syphilis knowledge among medical providers and students in Rhode Island. SAGE Open Med 2020; 8:2050312120902591. [PMID: 32110401 PMCID: PMC7000862 DOI: 10.1177/2050312120902591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background: In the United States, syphilis cases have increased dramatically over the
last decade. Recognition and timely diagnosis by medical providers are
essential to treating syphilis and preventing further transmission. Methods: From 2016 to 2017, a cross-sectional survey was performed among medical
students, residents, fellows, and attending physicians in Rhode Island.
Topics included demographics, level of medical training, experience
diagnosing and treating syphilis, and familiarity with the reverse testing
algorithm. Participants were asked 25 true/false questions to assess basic
knowledge of syphilis, which covered five domains: epidemiology,
transmission, clinical signs and symptoms, diagnosis, and treatment.
Univariate and bivariate analyses were performed to determine knowledge
levels across provider characteristics. Significance was defined as
p < 0.05. Results: Of the 231 participants, 45% were medical students, 34% were residents or
fellows, 11% were medicine attendings (non-infectious diseases), and 10%
were infectious diseases attendings. The overall mean score was 9.79 (out of
25; range = 0–23, p ⩽ 0.001). Mean scores differed
significantly (p < 0.001) across groups, including 7.68
for students (range = 0–16), 10.61 for residents/fellows (range = 3–17),
10.41 for non-infectious diseases attendings (range = 4–18), and 16.38 for
infectious diseases attendings (range = 6–23). Familiarity with the reverse
sequence algorithm was low with only 22% having heard of it. Infectious
diseases attendings were significantly more knowledgeable compared to other
groups. Overall and across domains, infectious diseases attendings had
significantly higher scores except when compared to non-infectious diseases
attendings in the epidemiology domain and residents/fellows in the
transmission domain. Conclusion: Overall syphilis knowledge among non-infectious diseases medical providers
was low. Improved education and clinical training are needed to promote
early diagnosis, treatment, and prevention efforts.
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Affiliation(s)
- John Bonnewell
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Sarah Magaziner
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Madeline C Montgomery
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Alexi Almonte
- Division of Infectious Diseases, Department of Medicine, The Miriam Hospital, Brown University, Providence, RI, USA
| | - Michael Carey
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Philip A Chan
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA.,Division of Infectious Diseases, Department of Medicine, The Miriam Hospital, Brown University, Providence, RI, USA
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Abstract
Objectives: Predictors of success among emerging adults (EAs; ages 18-25) within behavioral weight loss (BWL) trials are largely unknown. We examined whether early program engagement predicted overall engagement and weight loss in EAs. Methods: Data were pooled from 2 randomized controlled pilot trials in EAs. Participants (N = 99, 80% female, BMI = 33.7±5.1 kg/m²) received a 3-month BWL intervention. Weight was objectively assessed at 0 and 3 months; engagement was tracked weekly; retention was assessed at 3 months. Results: Greater engagement during the initial 4 weeks of treatment predicted greater weight loss (p = .001). Compared to those who did not engage in all 4 initial weeks, participants meeting this threshold experienced greater overall engagement (9.6 vs 4.2 weeks, p < .001), weight losses (intent-to-treat = -3.8% vs -1.3%, p = .004), and retention (78% vs 53%, p = .012). Conclusions: Early engagement in BWL is associated with better outcomes among EAs. Monitoring engagement in real-time during the initial 4 weeks of treatment may be necessary to intervene effectively. Early engagement did not vary by sex or race; future work should identify characteristics associated with poor early engagement.
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Affiliation(s)
- Jessica Gokee LaRose
- Associate Professor, Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA;,
| | - Joseph L. Fava
- Research Associate, The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI
| | - Autumn Lanoye
- Postdoctoral Fellow, Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA
| | - Laura J. Caccavale
- Postdoctoral Fellow, Children's Hospital of Richmond at Virginia Commonwealth University, Healthy Lifestyles Center, Richmond, VA
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Deutsch C, Bock BC, Lantini R, Walaska K, Rosen RK, Fava JL, Jennings EG, Foster R, Flanagan W. A text message delivered smoking cessation intervention: Design and rationale of the Text My Quit Study. Contemp Clin Trials 2019; 81:19-27. [PMID: 30999058 PMCID: PMC6550345 DOI: 10.1016/j.cct.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/05/2019] [Accepted: 04/13/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs. METHODS/DESIGN This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants. CONCLUSIONS This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion.
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Affiliation(s)
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Ryan Lantini
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Kristen Walaska
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Behavioral and Social Sciences, School of Public Health of Brown University, Providence, RI, United States
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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21
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Dulin AJ, Dale SK, Earnshaw VA, Fava JL, Mugavero MJ, Napravnik S, Hogan JW, Carey MP, Howe CJ. Resilience and HIV: a review of the definition and study of resilience. AIDS Care 2019; 30:S6-S17. [PMID: 30632778 DOI: 10.1080/09540121.2018.1515470] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We use a socioecological model of health to define resilience, review the definition and study of resilience among persons living with human immunodeficiency virus (PLWH) in the existing peer-reviewed literature, and discuss the strengths and limitations of how resilience is defined and studied in HIV research. We conducted a review of resilience research for HIV-related behaviors/outcomes of antiretroviral therapy (ART) adherence, clinic attendance, CD4 cell count, viral load, viral suppression, and/or immune functioning among PLWH. We performed searches using PubMed, PsycINFO and Google Scholar databases. The initial search generated 14,296 articles across the three databases, but based on our screening of these articles and inclusion criteria, n = 54 articles were included for review. The majority of HIV resilience research defines resilience only at the individual (i.e., psychological) level or studies individual and limited interpersonal resilience (e.g., social support). Furthermore, the preponderance of HIV resilience research uses general measures of resilience; these measures have not been developed with or tailored to the needs of PLWH. Our review suggests that a socioecological model of health approach can more fully represent the construct of resilience. Furthermore, measures specific to PLWH that capture individual, interpersonal, and neighborhood resilience are needed.
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Affiliation(s)
- Akilah J Dulin
- a Center for Health Equity Research, Department of Behavioral and Social Sciences , Brown University School of Public Health , Providence , RI , USA
| | - Sannisha K Dale
- b Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Valerie A Earnshaw
- c Department of Human Development and Family Sciences , University of Delaware , Newark , DE , USA
| | - Joseph L Fava
- d Centers for Behavioral and Preventive Medicine , The Miriam Hospital , Providence , RI , USA
| | - Michael J Mugavero
- e Division of Infectious Diseases, Department of Medicine, Center for AIDS Research , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sonia Napravnik
- f Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joseph W Hogan
- g Center for Statistical Sciences, Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Michael P Carey
- h Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior , The Miriam Hospital, Alpert Medical School of Brown University , Providence , RI , USA
| | - Chanelle J Howe
- i Centers for Epidemiology and Environmental Health, Department of Epidemiology , Brown University School of Public Health , Providence , RI , USA
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22
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Bock BC, Thind H, Fava JL, Dunsiger S, Guthrie KM, Stroud L, Gopalakrishnan G, Sillice M, Wu W. Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: The Healthy Active and in Control (HA1C) study. Complement Ther Med 2018; 42:125-131. [PMID: 30670230 DOI: 10.1016/j.ctim.2018.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study:Healthy Active and in Control (HA1C), examined the feasibility and acceptability of yoga as a complementary therapy for adults with Type-2 Diabetes (T2DM). DESIGN A 2-arm randomized clinical trial comparing Iyengar yoga with a supervised walking program. SETTING Hospital based gym-type facility and conference rooms. INTERVENTIONS Participants were randomized to a 12-week program of either; (1) a twice weekly Iyengar yoga, or (2) a twice-weekly program of standard exercise (SE). MAIN OUTCOME MEASURES Primary outcomes assessed feasibility and acceptability, including enrollment rates, attendance, study completion, and participant satisfaction. Secondary outcomes included HbA1c, physical activity, and measures of diabetes-related emotional distress, self-care and quality of life (QOL). Assessments were conducted at baseline, end of treatment, 6-months and 9-months post-enrollment. RESULTS Of 175 adults screened for eligibility, 48 (30 women, 18 men) were eligible and enrolled. The most common reasons for ineligibility were orthopedic restrictions, HbA1c levels <6.5 and BMI > 42. Session attendance was high (82% of sessions attended), as was follow-up completion rates (92%). Program satisfaction rated on a 5-point scale, was high among both Yoga (M = 4.63, SD = 0.57) and SE (M = 4.77, SD = 0.52) participants. Overall 44 adverse events (26 Yoga, 18 SE) were reported. Of these, six were deemed "possibly related" (e.g., neck strain, back pain), and 1 "probably related" (ankle pain after treadmill) to the study. Yoga produced significant reductions in HbA1c. Median HbA1c at 6 months was 1.25 units lower for Yoga compared to SE (95% CI: -2.54 -0.04). Greater improvements in diabetes self-care, quality of life, and emotional distress were seen among Yoga participants than among SE participants. Increases in mindfulness were seen in Yoga but not in SE. CONCLUSIONS The yoga intervention was highly feasible and acceptable, and produced improvements in blood glucose and psychosocial measures of diabetes management.
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Affiliation(s)
- B C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States.
| | - H Thind
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - J L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - S Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - K M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - L Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - G Gopalakrishnan
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - M Sillice
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
| | - W Wu
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States
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23
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Thind H, Fava JL, Guthrie KM, Stroud L, Gopalakrishnan G, Sillice M, Gidron N, Bock BC. Yoga as a Complementary Therapy for Adults with Type 2 Diabetes: Design and Rationale of the Healthy, Active, and in Control (HA1C) Study. Int J Yoga Therap 2018; 28:123-132. [PMID: 30130144 DOI: 10.17761/2018-00026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Diabetes is the seventh leading cause of death in the United States. For most patients, medication alone is not sufficient to achieve glycemic control; attention must also be paid to multiple healthy behaviors including diet, regular physical activity, and stress management. Yoga, a mindfulness practice with emphasis on relaxation, meditation, and deep breathing, may have special relevance to people with type 2 diabetes mellitus (T2DM). Yoga practice may positively affect stress and other self-care tasks that will contribute to improved glycemic control. The Healthy, Active, and in Control (HA1C) study is designed to examine the feasibility and acceptability of yoga among adult patients with T2DM. In this pilot randomized controlled trial, adults with T2DM were randomly assigned to either a 12-week Iyengar Yoga intervention given twice weekly, or a twice-weekly 12-week program of traditional exercise (e.g., walking, stationary cycling). Assessments are conducted at the end of treatment (12 weeks) and at 3 and 6 months postintervention. The HA1C study will assess feasibility and acceptability (e.g., attendance/retention rates, satisfaction with program), glycemic outcomes (e.g., HbA1c, fasting blood glucose, postprandial blood glucose), and changes in physiological (e.g., salivary cortisol) and behavioral factors (e.g., physical activity, diet) relevant to the management of T2DM. Focus groups are conducted at the end of the intervention to explore participants' experience with the program and their perception of the potential utility of yoga for diabetes management.
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Affiliation(s)
- Herpreet Thind
- 1. Assistant Professor, Department of Public Health, University of Massachusetts, Lowell, Mass
| | - Joseph L Fava
- 2. Research Associate, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, R.I
| | - Kate M Guthrie
- 3. Associate Professor of Psychiatry & Human Behavior, The Warren Alpert Medical School of Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, R.I
| | - Laura Stroud
- 3. Associate Professor of Psychiatry & Human Behavior, The Warren Alpert Medical School of Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, R.I
| | - Geetha Gopalakrishnan
- 4. Associate Professor of Medicine, The Warren Alpert Medical School of Brown University, Lifespan Center for Diabetes and Endocrinology, East Providence, R.I
| | - Marie Sillice
- 5. Postdoctoral Fellow, The Warren Alpert Medical School of Brown University, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, R.I
| | - Naama Gidron
- 6. Certified Iyengar Yoga Instructor, and Director, Motion Center Yoga Collective, Pawtucket, R.I
| | - Beth C Bock
- 7. Professor of Psychiatry & Human Behavior, The Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, R.I
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24
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Tolley EE, Guthrie KM, Zissette S, Fava JL, Gill K, Louw CE, Kotze P, Reddy K, MacQueen K. Optimizing adherence in HIV prevention product trials: Development and psychometric evaluation of simple tools for screening and adherence counseling. PLoS One 2018; 13:e0195499. [PMID: 29649249 PMCID: PMC5896947 DOI: 10.1371/journal.pone.0195499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/24/2018] [Indexed: 12/25/2022] Open
Abstract
Background Low adherence in recent HIV prevention clinical trials highlights the need to better understand, measure, and support product use within clinical trials. Conventional self-reported adherence instruments within HIV prevention trials, often relying on single-item questions, have proven ineffective. While objective adherence measures are desirable, none currently exist that apply to both active and placebo arms. Scales are composed of multiple items in the form of questions or statements that, when combined, measure a more complex construct that may not be directly observable. When psychometrically validated, such measures may better assess the multiple factors contributing to adherence/non-adherence. This study aimed to develop and psychometrically evaluate tools to screen and monitor trial participants’ adherence to HIV prevention products within the context of clinical trial research. Methods and findings Based on an extensive literature review and conceptual framework, we identified and refined 86 items assessing potential predictors of adherence and 48 items assessing adherence experience. A structured survey, including adherence items and other variables, was administered to former ASPIRE and Ring Study participants and similar non-trial participants (n = 709). We conducted exploratory factor analyses (EFA) to identify a reduced set of constructs and items that could be used at screening to predict potential adherence, and at follow-up to monitor and intervene on adherence. We examined associations with other variables to assess content and construct validity. The EFA of screener items resulted in a 6-factor solution with acceptable to very good internal reliability (α: .62-.84). Similar to our conceptual framework, factors represent trial-related commitment (Distrust of Research and Commitment to Research); alignment with trial requirements (Visit Adherence and Trial Incompatibility); Belief in Trial Benefits and Partner Disclosure. The EFA on monitoring items resulted in 4 Product-specific factors that represent Vaginal Ring Doubts, Vaginal Ring Benefits, Ring Removal, and Side Effects with good to very good internal reliability (α = .71-.82). Evidence of content and construct validity was found; relationship to social desirability bias was examined. Conclusions These scales are easy and inexpensive to administer, available in several languages, and are applicable regardless of randomization. Once validated prospectively, they could (1) screen for propensity to adhere, (2) target adherence support/counselling, and (3) complement biomarker measures in determining true efficacy of the experimental product.
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Affiliation(s)
| | - Kate Morrow Guthrie
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Deptartment of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Seth Zissette
- FHI 360, Durham, North Carolina, United States of America
| | - Joseph L. Fava
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
| | | | - Cheryl E. Louw
- Madibeng Centre for Research, Brits, South Africa
- University of Pretoria, Department of Family Medicine, Faculty of Health Sciences, Hatfield, South Africa
| | - Philip Kotze
- Qhakaza Mbokodo Research Clinic, Ladysmith, South Africa
| | - Krishnaveni Reddy
- Wits Reproductive Health & HIV Institute, Johannesburg, South Africa
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25
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Thind H, Sillice MA, Fava JL, Lantini R, Horowitz S, Jennings E, Rosen RK, Carmody J, Becker BM, Marcus BH, Bock BC. Development and Validation of the Outcome Expectations for Yoga Scale. Am J Health Behav 2017; 41:796-802. [PMID: 29025507 DOI: 10.5993/ajhb.41.6.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our objective was to develop an instrument that can measure outcome expectations of yoga and to evaluate the instrument for internal consistency and initial construct validity. METHODS A 20-item scale was developed to assess physical, mental, and spiritual health benefits related to yoga practice among adults. The scale was tested in a baseline survey with adults participating in a clinical trial. Principal component analysis was used to investigate the internal structure of the measure. Outcome expectations for yoga were examined for demographic differences. RESULTS The sample (N = 185) was 54% women, 89% white and had a mean age of 46 years. The final 20-item scale had high item loadings that ranged from .57 to .88 with a Cronbach's alpha value of .96. Significant differences were found in outcome expectation score by sex. CONCLUSION This newly developed scale can be used to assess outcome expectations for yoga and tailor interventions to promote adherence to yoga practice.
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Affiliation(s)
- Herpreet Thind
- Assistant Professor, Department of Public Health, University of Massachusetts Lowell, Lowell, MA;,
| | - Marie A. Sillice
- Postdoctoral Fellow, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Joseph L. Fava
- Research Associate, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Ryan Lantini
- Project Director, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Santina Horowitz
- Project Director, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Ernestine Jennings
- Assistant Professor, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Rochelle K. Rosen
- Assistant Professor, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - James Carmody
- Professor, University of Massachusetts Medical School, Worcester, MA
| | - Bruce M. Becker
- Professor, Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Bess H. Marcus
- Professor and Chair, Department of Family Medicine and Public Health, University of San Diego, San Diego, CA
| | - Beth C. Bock
- Professor, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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26
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Bock BC, Thind H, Dunsiger S, Fava JL, Jennings E, Becker BM, Marcus BH, Rosen RK, Sillice MA. Who Enrolls in a Quit Smoking Program with Yoga Therapy? Am J Health Behav 2017; 41:740-749. [PMID: 29025502 DOI: 10.5993/ajhb.41.6.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Yoga may improve stress, affect, and weight control, all of which are commonly cited barriers to quitting smoking. However, the importance of these concerns may vary by sex, race, ethnicity, and age. We examined smoking-relevant characteristics of individuals enrolling in an 8-week randomized controlled trial testing yoga as a complementary treatment to standard smoking cessation. METHODS Of 958 callers, 227 were eligible and enrolled. RESULTS The sample was 55% female, 86% non-Hispanic white, with a mean age of 46 years (SD = 12). Males smoked more cigarettes/ day than females and had lower motivation to quit smoking. Females were more likely to smoke for weight control, social and mood-related reasons, and had higher expectations for the efficacy of yoga. Age was negatively associated with the presence of other smokers in the household, and smoking in response to negative moods, and was positively associated with smoking rate, and confidence in quitting. CONCLUSIONS This study demonstrated that both males and females were interested in a program offering yoga as a complementary therapy for smoking cessation. However, there were both sex and age-related differences with respect to smoking-related variables that may suggest a need to adapt the intervention for sub-populations.
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Affiliation(s)
- Beth C. Bock
- Professor, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI;,
| | - Herpreet Thind
- Assistant Professor, Department of Public Health, University of Massachusetts Lowell, Lowell, MA
| | - Shira Dunsiger
- Assistant Professor, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Joseph L. Fava
- Research Associate, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Ernestine Jennings
- Assistant Professor, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Bruce M. Becker
- Professor, Departments of Emergency Medicine and Behavioral Social Science, Alpert Medical School of Brown University, Providence, RI
| | - Bess H. Marcus
- Professor and Chair, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA
| | - Rochelle K. Rosen
- Assistant Professor, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Marie A. Sillice
- Post-Doctoral Fellow, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI
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27
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Weld ED, Hiruy H, Guthrie KM, Fava JL, Vargas SE, Buckheit K, Buckheit R, Spiegel H, Breakey J, Fuchs EJ, Hendrix CW. A Comparative Pre-Phase I Study of the Impact of Gel Vehicle Volume on Distal Colon Distribution, User Experience, and Acceptability. AIDS Res Hum Retroviruses 2017; 33:440-447. [PMID: 27824253 DOI: 10.1089/aid.2016.0167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
For persons at risk of HIV infection who practice receptive anal intercourse (RAI), topical rectal microbicides represent a promising option for coitally dependent protection. The study compared colorectal distribution and user sensory experiences of two different volumes of rectal gel for suitability as rectal microbicide. Eight HIV-negative men with a history of recent RAI were enrolled into a two-period, sequence-randomized dosing study comparing 3.5 and 10 ml of radiolabeled (1 mCi 99mTc-DTPA) universal placebo, hydroxyethyl cellulose gel. Each participant received two doses in the research unit, one of each volume, separated by a washout period of at least 2 weeks. Each research unit dose was followed by a self-administered take-home dose in the context of preparing for RAI. Safety and gastrointestinal distribution were assessed after the research unit doses, safety, perceptibility, and acceptability, were assessed after take-home doses. There were no adverse effects of Grade 2 or higher and all resolved spontaneously. Both volumes were well tolerated and received high acceptability scores. Perceptibility scores showed meaningful effect size differences ranging from Cohen's d = 0.5 to d = 1.2. The 3.5 and 10 ml gel volumes distributed similarly (p > .2) within the rectosigmoid, ranging from 0.69 to 18.84 cm and 1.21 to 19.01 cm from the anorectal junction, respectively. Both volumes covered the typical gastrointestinal distribution of ejaculate following simulated intercourse based on other studies. Either of these gel volumes could reasonably be pursued for the next phase of development of rectal microbicides.
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Affiliation(s)
- Ethel D Weld
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 2 Department of Medicine (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Hiwot Hiruy
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 3 Department of Pediatrics (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Kate Morrow Guthrie
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
- 5 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University . Providence, Rhode Island
| | - Joseph L Fava
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
| | - Sara E Vargas
- 4 Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence, Rhode Island
- 5 Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University . Providence, Rhode Island
| | | | | | | | - Jennifer Breakey
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Edward J Fuchs
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Craig W Hendrix
- 1 Department of Medicine (Division of Clinical Pharmacology), The Johns Hopkins University School of Medicine , Baltimore, Maryland
- 2 Department of Medicine (Division of Infectious Diseases), The Johns Hopkins University School of Medicine , Baltimore, Maryland
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van den Berg JJ, Isabel Fernández M, Fava JL, Operario D, Rudy BJ, Wilson PA. Using Syndemics Theory to Investigate Risk and Protective Factors Associated with Condomless Sex Among Youth Living with HIV in 17 U.S. Cities. AIDS Behav 2017; 21:833-844. [PMID: 27624727 DOI: 10.1007/s10461-016-1550-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Identifying risk and protective factors associated with condomless sex among youth living with HIV is imperative for developing effective HIV prevention strategies. A cross-sectional sample of 1728 participants, 12-26 years of age, recruited from adolescent medicine clinics in 17 U.S. cities completed an audio-computer assisted self-interview with questions about their substance use, psychosocial factors, and attitudinal and behavioral factors. Guided by syndemics theory, a path analysis was used to assess the interrelations of these factors. Analyses of model fit statistics indicated statistically significant direct pathways between substance use, psychosocial factors, self-efficacy for risk-reduction, alternative risk-reduction attitudes and behaviors and condomless sex. The total indirect effect of self-efficacy for risk-reduction on condomless sex through alternative risk-reduction attitudes and behaviors was also significant. Multi-faceted, tailored interventions that address individual risk and protective factors and their combined synergistic effects are urgently needed to prevent condomless sex among this population.
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Affiliation(s)
- Jacob J van den Berg
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA.
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - M Isabel Fernández
- Division of Health Professions, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Bret J Rudy
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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LaRose JG, Tate DF, Lanoye A, Fava JL, Jelalian E, Blumenthal M, Caccavale LJ, Wing RR. Adapting evidence-based behavioral weight loss programs for emerging adults: A pilot randomized controlled trial. J Health Psychol 2017; 24:870-887. [PMID: 28810394 DOI: 10.1177/1359105316688951] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Emerging adults are at high risk of obesity but behavioral weight loss programs do not meet their needs. Emerging adults ( N = 52, age = 22.3 ± 2 years, body mass index = 34.2 ± 5.5 kg/m2, 46.2% non-Hispanic White) were randomly assigned to one of three behavioral weight loss programs adapted based on formative work: face-to-face behavioral weight loss, web-based behavioral weight loss, or web plus optional community sessions (Hybrid). Assessments occurred at 0 and 3 months. Engagement and self-monitoring were highest in Hybrid. Intent-to-treat weight losses were -2.8 ± 2.9 percent in face-to-face behavioral weight loss, -2.2 ± 4.5 percent in web-based behavioral weight loss, and 4.8 ± 4.9 percent in Hybrid. Percent achieving ⩾5 percent weight loss was highest in Hybrid (63%). Findings suggest potential for adapted behavioral weight loss to promote engagement and weight loss in emerging adults.
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Affiliation(s)
| | | | | | | | | | | | | | - Rena R Wing
- 3 The Miriam Hospital, USA.,4 Brown University, USA
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Leahey TM, LaRose JG, Lanoye A, Fava JL, Wing RR. Secondary data analysis from a randomized trial examining the effects of small financial incentives on intrinsic and extrinsic motivation for weight loss. Health Psychol Behav Med 2017; 5:129-144. [PMID: 31106034 DOI: 10.1080/21642850.2016.1276460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives To examine whether (a) an obesity treatment involving financial incentives yields higher levels of extrinsic motivation for weight management compared to an identical intervention without incentives, (b) extrinsic motivation for weight management mediates, or accounts for, the difference in weight loss outcomes between the two interventions, and (c) there is any evidence that financial incentives and associated extrinsic motivation "crowd out" intrinsic motivation for weight control. Methods Participants (N=153, 80.4% Female; BMI = 33.2 ± 5.9) were randomly assigned to a 3-month Web-based behavioral weight loss program (WBWL) or the same program plus small financial incentives delivered consistent with behavioral economics and behavior change theories (WBWL+$). Weight was objectively assessed at baseline, post-treatment (month 3), and after a 9-month no-treatment follow-up phase (month 12). Intrinsic and extrinsic motivation for weight management were assessed at months 3 and 12 using a modified version of the Treatment Self-Regulation Questionnaire, with questions added to specifically target extrinsic motivation related to incentives. Results Compared to WBWL alone, WBWL+$ had better weight loss and higher levels of both extrinsic and intrinsic motivation for weight management (p's≤.02). Moreover, during the no-treatment follow-up phase, the trajectories of weight regain did not significantly differ between WBWL and WBWL+$ (p=.58). Extrinsic motivation was not a significant mediator of treatment outcomes. Conclusions Modest financial incentives delivered consistent with behavioral economics and behavior change theories do not undermine intrinsic motivation for weight management during obesity treatment; in fact, they yield higher levels of both extrinsic and intrinsic motivation. Additional research is needed to better understand the mechanisms by which incentives improve outcomes in health behavior change interventions.
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Affiliation(s)
- Tricia M Leahey
- University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT 06269-1101, USA;
| | - Jessica Gokee LaRose
- Virginia Commonwealth University School of Medicine, 830 E. Main Street, PO Box 980430, Richmond, VA, 23298, USA;
| | - Autumn Lanoye
- Virginia Commonwealth University School of Medicine, 830 E. Main Street, PO Box 980430, Richmond, VA, 23298, USA;
| | - Joseph L Fava
- The Miriam Hospital's Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA;
| | - Rena R Wing
- The Miriam Hospital's Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA;
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Bock BC, Lantini R, Thind H, Walaska K, Rosen RK, Fava JL, Barnett NP, Scott-Sheldon LA. The Mobile Phone Affinity Scale: Enhancement and Refinement. JMIR Mhealth Uhealth 2016; 4:e134. [PMID: 27979792 PMCID: PMC5200845 DOI: 10.2196/mhealth.6705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 12/16/2022] Open
Abstract
Background Existing instruments that assess individuals’ relationships with mobile phones tend to focus on negative constructs such as addiction or dependence, and appear to assume that high mobile phone use reflects pathology. Mobile phones can be beneficial for health behavior change, disease management, work productivity, and social connections, so there is a need for an instrument that provides a more balanced assessment of the various aspects of individuals’ relationships with mobile phones. Objective The purpose of this research was to develop, revise, and validate the Mobile Phone Affinity Scale, a multi-scale instrument designed to assess key factors associated with mobile phone use. Methods Participants (N=1058, mean age 33) were recruited from Amazon Mechanical Turk between March and April of 2016 to complete a survey that assessed participants’ mobile phone attitudes and use, anxious and depressive symptoms, and resilience. Results Confirmatory factor analysis supported a 6-factor model. The final measure consisted of 24 items, with 4 items on each of 6 factors: Connectedness, Productivity, Empowerment, Anxious Attachment, Addiction, and Continuous Use. The subscales demonstrated strong internal consistency (Cronbach alpha range=0.76-0.88, mean 0.83), and high item factor loadings (range=0.57-0.87, mean 0.75). Tests for validity further demonstrated support for the individual subscales. Conclusions Mobile phone affinity may have an important impact in the development and effectiveness of mobile health interventions, and continued research is needed to assess its predictive ability in health behavior change interventions delivered via mobile phones.
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Affiliation(s)
- Beth C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, United States.,Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Ryan Lantini
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Herpreet Thind
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kristen Walaska
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
| | - Lori Aj Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, United States.,Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
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Abstract
Behaviorally descriptive adjectives and personality trait terms have been analyzed periodically by many psychological researchers and practitioners during the last half of this century. This analysis of personality-descriptive adjectives and terms has led to the development of several widely used adjective checklists for personality assessment and the postulation and the construct validation of several personality models. Foremost among the adjective checklists have been the 1948 Activity Vector Analysis (AVA), the 1950 Adjective Check List (ACL), and the more recent Personality Adjective Check List (PACL) in 1987. The first descriptions and reports of their developmental and validation research appeared in the professional refereed literature, respectively by Clarke in 1956, Gough in 1960, and Strack in 1987. The ACL contains 300 adjectives, various forms of the AVA contain 81 to 87 adjectives, and the PACL contains 153 adjectives. The dimensionality of personality models and the number of scales interpreted in the protocols from these instruments have either remained stable as in the case of AVA (4 dimensions, 6 scales) or have been quite variable over time. For example, the ACL was originally 5-dimensional with 6 scales being interpreted. Currently, the ACL yields 37 interpretable scales, and the PACL perhaps a 5-factor structure.
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Bock BC, Barnett NP, Thind H, Rosen R, Walaska K, Traficante R, Foster R, Deutsch C, Fava JL, Scott-Sheldon LAJ. A text message intervention for alcohol risk reduction among community college students: TMAP. Addict Behav 2016; 63:107-13. [PMID: 27450909 PMCID: PMC7100963 DOI: 10.1016/j.addbeh.2016.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/22/2016] [Accepted: 07/15/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Students at community colleges comprise nearly half of all U.S. college students and show higher risk of heavy drinking and related consequences compared to students at 4-year colleges, but no alcohol safety programs currently target this population. OBJECTIVE To examine the feasibility, acceptability, and preliminary efficacy of an alcohol risk-reduction program delivered through text messaging designed for community college (CC) students. METHODS Heavy drinking adult CC students (N=60) were enrolled and randomly assigned to the six-week active intervention (Text Message Alcohol Program: TMAP) or a control condition of general motivational (not alcohol related) text messages. TMAP text messages consisted of alcohol facts, strategies to limit alcohol use and related risks, and motivational messages. Assessments were conducted at baseline, week 6 (end of treatment) and week 12 (follow up). RESULTS Most participants (87%) completed all follow up assessments. Intervention messages received an average rating of 6.8 (SD=1.5) on a 10-point scale. At week six, TMAP participants were less likely than controls to report heavy drinking and negative alcohol consequences. The TMAP group also showed significant increases in self-efficacy to resist drinking in high risk situations between baseline and week six, with no such increase among controls. Results were maintained through the week 12 follow up. CONCLUSIONS The TMAP alcohol risk reduction program was feasible and highly acceptable indicated by high retention rates through the final follow up assessment and good ratings for the text message content. Reductions in multiple outcomes provide positive indications of intervention efficacy.
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Affiliation(s)
- Beth C Bock
- Centers for Behavioral and Preventive Medicine, Brown Medical School, The Miriam Hospital, Providence, RI 02903, United States.
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies and Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI 02912, United States.
| | - Herpreet Thind
- Department of Community Health and Sustainability, University of Massachusetts Lowell, MA 01854, United States.
| | - Rochelle Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Brown Medical School, Providence, RI 02903, United States.
| | - Kristen Walaska
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02903, United States.
| | - Regina Traficante
- Community College of Rhode Island, Psychology Department, Warwick, RI 02886, United States.
| | - Robert Foster
- Live Inspired, LLC, Washington, DC 20002, United States.
| | - Chris Deutsch
- Live Inspired, LLC, Washington, DC 20002, United States.
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02903, United States.
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Brown Medical School, Providence, RI 02903, United States.
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Leahey TM, Fava JL, Seiden A, Fernandes D, Doyle C, Kent K, La Rue M, Mitchell M, Wing RR. A randomized controlled trial testing an Internet delivered cost-benefit approach to weight loss maintenance. Prev Med 2016; 92:51-57. [PMID: 27095323 PMCID: PMC5067166 DOI: 10.1016/j.ypmed.2016.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 01/16/2023]
Abstract
Weight loss maintenance is a significant challenge in obesity treatment. During maintenance the "costs" of adhering to weight management behaviors may outweigh the "benefits." This study examined the efficacy of a novel approach to weight loss maintenance based on modifying the cost-benefit ratio. Individuals who achieved a 5% weight loss (N=75) were randomized to one of three, 10-month maintenance interventions. All interventions were delivered primarily via the Internet. The Standard arm received traditional weight maintenance strategies. To increase benefits, or rewards, for maintenance behaviors, the two cost-benefit intervention conditions received weekly monetary rewards for self-monitoring and social reinforcement via e-coaching. To decrease behavioral costs (boredom) and increase novelty, participants in the cost-benefit conditions also monitored different evidence-based behaviors every two weeks (e.g., Weeks 1 & 2: steps; Week 3 & 4: red foods). The primary difference between the cost-benefit interventions was type of e-coach providing social reinforcement: Professional (CB Pro) or Peer (CB Peer). Study procedures took place in Providence, RI from 2013 to 2014. Retention was 99%. There were significant group differences in weight regain (p=.01). The Standard arm gained 3.5±5.7kg. In contrast, participants in CB Pro and CB Peer lost an additional 1.8±7.0kg and 0.5±6.4kg, respectively. These results suggest that an Internet delivered cost-benefit approach to weight loss maintenance may be effective for long-term weight control. In addition, using peer coaches to provide reinforcement may be a particularly economic alternative to professionals. These data are promising and provide support for a larger, longer trial.
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Affiliation(s)
- Tricia M Leahey
- University of Connecticut, Department of Allied Health Sciences, 358 Mansfield Road, Unit 1101, Storrs, CT 06269-1101, USA; The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA.
| | - Joseph L Fava
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
| | - Andrew Seiden
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
| | - Denise Fernandes
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
| | - Caroline Doyle
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
| | - Kimberly Kent
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
| | - Molly La Rue
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
| | - Marc Mitchell
- University of Toronto, University Health Network, Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 1R7, Canada
| | - Rena R Wing
- The Miriam Hospital/Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903, USA
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Thind H, Jennings E, Fava JL, Sillice MA, Becker BM, Hartman SJ, Bock BC. Differences between Men and Women Enrolling in Smoking Cessation Programs Using Yoga as a Complementary Therapy. J Yoga Phys Ther 2016; 6. [PMID: 27683623 PMCID: PMC5036391 DOI: 10.4172/2157-7595.1000245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study compares the characteristics of men and women, respectively, participating in two randomized controlled pilot studies whose primary aims were to test the feasibility of yoga as a complementary therapy for smoking cessation. Participants were aged 18-65, generally healthy and were daily smokers. Analysis of variance (ANOVA) and chi-square tests examined gender differences in smoking rate, potential treatment mediators, and covariates (e.g., smoking history, health status, weight concerns, mood, and prior withdrawal symptoms). A total of 55 women and 38 men participated in the study. Differences between men and women at enrollment included: women reported significantly greater withdrawal (p<0.005), anxiety (p=0.032), and depression (p=0.027) symptoms than men. More women than men (91% vs. 66%) reported having been told by their doctor to quit smoking (p=0.003), had an existing smoking-related illness (33% vs. 13%; p=0.032), and reported smoking for weight control (15% vs. 0%; p=0.014). Results showed good feasibility for recruiting both men and women into a study using yoga as a complementary therapy for smoking cessation. Results also indicate that interventions may need to be tailored to meet different needs (e.g., addressing co-morbid depression) between men and women.
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Affiliation(s)
- Herpreet Thind
- Department of Community Health and Sustainability, College of Health Sciences, University of Massachusetts Lowell, USA
| | | | - Joseph L Fava
- The Miriam Hospital, 164 Summit Avenue, Providence RI, 02906, USA
| | - Marie A Sillice
- Department of Psychiatry and Human Behavior, Brown Medical School, Brown University, The Miriam Hospital, USA
| | - Bruce M Becker
- Department of Emergency Medicine, Behavioral and Social Sciences, Alpert Medical School, Brown University, Rhode Island Hospital, USA
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, UC San Diego Moores Cancer Center, 3855 Health Sciences Drive, USA
| | - Beth C Bock
- Department of Psychiatry and Human Behavior, Brown Medical School, Brown University, The Miriam Hospital, USA
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Fava JL, van den Berg JJ, Rosen RK, Salomon L, Vargas S, Christensen AL, Pinkston M, Morrow KM. Measuring self-efficacy to use vaginal microbicides: the Microbicide Use Self-Efficacy instrument. Sex Health 2016; 10:339-47. [PMID: 23806676 DOI: 10.1071/sh13013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 05/01/2013] [Indexed: 12/30/2022]
Abstract
UNLABELLED Objectives To evaluate the psychometric properties of the Microbicide Use Self-Efficacy (MUSE) instrument and to examine correlates of self-efficacy to use vaginal microbicides among a sample of racially and ethnically diverse women living in the north-eastern United States. METHODS Exploratory and confirmatory factor analytic methods were used to explore and determine the dimensionality and psychometric properties of the MUSE instrument. Construct validity was assessed by examining the relationships of the MUSE instrument to key sexual behaviour, partner communication, relationship and psychosocial variables. RESULTS Two dimensions of self-efficacy to use microbicides were psychometrically validated and identified as 'Adherence and Access' and 'Situational Challenges.' The two four-item subscales measuring Adherence and Access and Situational Challenges had reliability coefficients of 0.78 and 0.85, respectively. Correlates of the two measures were tested at a Bonferroni-adjusted α level of P=0.001, and 19 of 43 variables analysed were found to significantly relate to Adherence and Access, whereas 16 of 43 variables were significantly related to Situational Challenges. Of the 35 significant relationships, 32 were in the domains of partner communication, partner relationships, and behavioural and psychosocial variables. CONCLUSIONS The MUSE instrument demonstrated strong internal validity, reliability and initial construct validity. The MUSE instrument can be a useful tool in capturing the multidimensional nature of self-efficacy to use microbicides among diverse populations of women.
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Affiliation(s)
- Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02906, USA
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Guthrie KM, Dunsiger S, Vargas SE, Fava JL, Shaw JG, Rosen RK, Kiser PF, Kojic EM, Friend DR, Katz DF. Perceptibility and the "Choice Experience": User Sensory Perceptions and Experiences Inform Vaginal Prevention Product Design. AIDS Res Hum Retroviruses 2016; 32:1022-1030. [PMID: 26942455 DOI: 10.1089/aid.2015.0275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The development of pericoital (on demand) vaginal HIV prevention technologies remains a global health priority. Clinical trials to date have been challenged by nonadherence, leading to an inability to demonstrate product efficacy. The work here provides new methodology and results to begin to address this limitation. We created validated scales that allow users to characterize sensory perceptions and experiences when using vaginal gel formulations. In this study, we sought to understand the user sensory perceptions and experiences (USPEs) that characterize the preferred product experience for each participant. Two hundred four women evaluated four semisolid vaginal formulations using the USPE scales at four randomly ordered formulation evaluation visits. Women were asked to select their preferred formulation experience for HIV prevention among the four formulations evaluated. The scale scores on the Sex-associated USPE scales (e.g., Initial Penetration and Leakage) for each participant's selected formulation were used in a latent class model analysis. Four classes of preferred formulation experiences were identified. Sociodemographic and sexual history variables did not predict class membership; however, four specific scales were significantly related to class: Initial Penetration, Perceived Wetness, Messiness, and Leakage. The range of preferred user experiences represented by the scale scores creates a potential target range for product development, such that products that elicit scale scores that fall within the preferred range may be more acceptable, or tolerable, to the population under study. It is recommended that similar analyses should be conducted with other semisolid vaginal formulations, and in other cultures, to determine product property and development targets.
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Affiliation(s)
- Kate Morrow Guthrie
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Shira Dunsiger
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Sara E. Vargas
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joseph L. Fava
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Julia G. Shaw
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Rochelle K. Rosen
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Patrick F. Kiser
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | - E. Milu Kojic
- Immunology Center, The Miriam Hospital, Providence, Rhode Island
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - David F. Katz
- Departments of Biomedical Engineering & Obstetrics/Gynecology, Duke University, Durham, North Carolina
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Serber ER, Fava JL, Christon LM, Buxton AE, Goldberger JJ, Gold MR, Rodrigue JR, Frisch MB. Positive Psychotherapy to Improve Autonomic Function and Mood in ICD Patients (PAM-ICD): Rationale and Design of an RCT Currently Underway. Pacing Clin Electrophysiol 2016; 39:458-70. [PMID: 26813033 DOI: 10.1111/pace.12820] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/17/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Improving mental and physical health of patients with implantable cardioverter defibrillators (ICD) is critical because this group is at high risk for ventricular arrhythmias and sudden death and depressed or anxious cardiovascular disease (CVD) patients appear to be at even higher risk for mortality compared to nondepressed or nonanxious CVD patients. Further, autonomic dysfunction is present in these patients, and negative emotions and arrhythmias form a downward spiral further worsening mood, well-being, and cardiovascular health. Much research demonstrates that positive emotion is related to health benefits, improved physiology, and increased survival. METHODS AND RESULTS This is a two-arm randomized controlled trial aiming to recruit 60 adult ICD patients comparing 12 individually delivered, weekly sessions of: (1) a positive emotion-focused cognitive-behavioral therapy (Quality of Life Therapy [QOLT]), and (2) Heart Healthy Education. Autonomic functioning, heart rhythm indices, and psychosocial health are measured at baseline, 3 months, and 9 months. The first goal is feasibility and acceptability, with the primary outcome being arrhythmic event frequency data. CONCLUSION This study is designed to test whether QOLT produces changes in mood, quality of life/well-being, autonomic function, and arrhythmic and ICD therapy event rates. This feasibility trial is a foundational step for the next trial of QOLT to help determine whether a 3-month QOLT trial can reduce arrhythmias occurrences among ICD patients, and examine a mechanism of autonomic functioning. This study may help to develop and implement new medical or psychological therapies for ICD patients.
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Affiliation(s)
- Eva R Serber
- Medical University of South Carolina, Charleston, South Carolina
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | | | - Alfred E Buxton
- Beth Israel Deaconess Medical Center and Harvard University, Boston, Massachusetts
| | | | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center and Harvard University, Boston, Massachusetts
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Vargas SE, Fava JL, Severy L, Rosen RK, Salomon L, Shulman L, Guthrie KM. Psychometric Properties and Validity of a Multi-dimensional Risk Perception Scale Developed in the Context of a Microbicide Acceptability Study. Arch Sex Behav 2016; 45:415-428. [PMID: 26621151 PMCID: PMC4707104 DOI: 10.1007/s10508-015-0619-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Currently available risk perception scales tend to focus on risk behaviors and overall risk (vs partner-specific risk). While these types of assessments may be useful in clinical contexts, they may be inadequate for understanding the relationship between sexual risk and motivations to engage in safer sex or one's willingness to use prevention products during a specific sexual encounter. We present the psychometric evaluation and validation of a scale that includes both general and specific dimensions of sexual risk perception. A one-time, audio computer-assisted self-interview was administered to 531 women aged 18-55 years. Items assessing sexual risk perceptions, both in general and in regards to a specific partner, were examined in the context of a larger study of willingness to use HIV/STD prevention products and preferences for specific product characteristics. Exploratory and confirmatory factor analyses yielded two subscales: general perceived risk and partner-specific perceived risk. Validity analyses demonstrated that the two subscales were related to many sociodemographic and relationship factors. We suggest that this risk perception scale may be useful in research settings where the outcomes of interest are related to motivations to use HIV and STD prevention products and/or product acceptability. Further, we provide specific guidance on how this risk perception scale might be utilized to understand such motivations with one or more specific partners.
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Affiliation(s)
- Sara E Vargas
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Lawrence Severy
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Liz Salomon
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
| | | | - Kate Morrow Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Bock BC, Thind H, Fava JL, Walaska K, Barnett NP, Rosen R, Traficante R, Lantini R. Development of the Mobile Phone Attachment Scale. Proc Annu Hawaii Int Conf Syst Sci 2016; 2016:3401-3407. [PMID: 30034299 PMCID: PMC6053277 DOI: 10.1109/hicss.2016.424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Existing instruments that assess the individual's relationship with technology tend to focus on negative constructs and assume that a high use of technology reflects pathology. Since technology use can be beneficial, there is a need for a more balanced instrument. An initial survey to assess the individual's relationship with their mobile phone was developed, checked for face validity and the resulting survey was administered online to students at local colleges. 146 adults (mean age=25.5 years) completed surveys. Principal Component Analysis with varimax rotation produced a final 27-item scale with factor loadings from .50 to .81, representing 4 components: "Usefulness", "Anxious Attachment", "Addiction" and "24/7" (continuous use). This study produced an instrument to assess multiple aspects of the individuals' relationship to their mobile phone. Additional work is needed to validate this measure in other populations, with larger samples, and to assess its predictive ability in mHealth interventions delivered through mobile phones.
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Gaskins RB, Jennings EG, Thind H, Fava JL, Horowitz S, Lantini R, Becker BM, Bock BC. Recruitment and initial interest of men in yoga for smoking cessation: QuitStrong, a randomized control pilot study. Transl Behav Med 2015; 5:177-88. [PMID: 26029280 DOI: 10.1007/s13142-014-0295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Innovative treatments like yoga for men's smoking cessation (SC) are lacking. To examine the feasibility and acceptability of yoga for men's SC. We randomly assigned eligible men (smoker, ≥5 cigarettes/day, age 18-65) to receive cognitive behavioral therapy for SC, plus a yoga or wellness program. Measures included feasibility (recruitment, class attendance) and acceptability (customer satisfaction). We enrolled 38 of 49 eligible men of 167 screened in response to ads (mean age 39.9 years, ±13.7) who smoked on average 18.6 cigarettes/day (±8.3). Wellness (75.8 %) versus yoga (56 %) men attended more SC classes, p < 0.01. Sixty percent attended ≥1 yoga class. Men reported greater satisfaction with in-house versus community yoga classes. Wellness appears to be the preferred intervention; results indicated that it may be more feasible and showed increased attendance at smoking classes. To be fully feasible, yoga + SC may need to be a unified program offering all classes tailored for men and in the same location.
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Affiliation(s)
- Ronnesia B Gaskins
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA ; Brown University/Brown-Alpert Medical School, Providence, USA
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903 USA ; Brown University/Brown-Alpert Medical School, Providence, USA
| | - Herpreet Thind
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903 USA ; Brown University/Brown-Alpert Medical School, Providence, USA
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903 USA
| | - Santina Horowitz
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903 USA
| | - Ryan Lantini
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903 USA
| | - Bruce M Becker
- Department of Emergency Medicine, RI Hospital, Providence, USA ; Brown University/Brown-Alpert Medical School, Providence, USA
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 1 Hoppin St, Providence, RI 02903 USA ; Brown University/Brown-Alpert Medical School, Providence, USA
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Morrow KM, Rosen RK, Fava JL, Rohan L, Kojic EM, Friend D, Katz D, Buckheit R. “He Said, She Said.” Exploring Couples' Sensory Perceptions and Experiences with Vaginal Gels & Film: Implications for Microbicide Development. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5158.abstract] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kathleen M. Morrow
- Miriam Hospital & Alpert Medicial School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, RI, United States
| | - Rochelle K. Rosen
- Miriam Hospital & Brown University School of Public Health, Center for Behavioral and Preventive Medicine, Providence, RI, United States
| | - Joseph L. Fava
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, United States
| | - Lisa Rohan
- Magee Womens Research Institute, Pittsburg, PA, United States
| | - Erna M. Kojic
- Miriam Hospital & Alpert Medical School of Brown University, Division of Immunology, Providence, RI, United States
| | | | - David Katz
- Duke University, Biomedical Engineering and Ob/Gyn, Durham, NC, United States
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Bock BC, Rosen RK, Fava JL, Gaskins RB, Jennings E, Thind H, Carmody J, Dunsiger SI, Gidron N, Becker BM, Marcus BH. Testing the efficacy of yoga as a complementary therapy for smoking cessation: design and methods of the BreathEasy trial. Contemp Clin Trials 2014; 38:321-32. [PMID: 24937018 DOI: 10.1016/j.cct.2014.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Smokers trying to quit encounter many challenges including nicotine withdrawal symptoms, cigarette craving, increased stress and negative mood and concern regarding weight gain. These phenomena make it difficult to successfully quit smoking. Studies in non-smoking populations show that yoga reduces stress and negative mood and improves weight control. By increasing mindfulness we anticipate that yoga may also improve smokers' ability to cope with the negative symptoms associated with quitting. Yoga may also improve cognitive deliberation which is needed to make effective choices and avoid smoking in tempting situations. METHODS/DESIGN The BreathEasy study is a rigorous, randomized controlled clinical trial examining the efficacy of Iyengar yoga as a complementary therapy to cognitive-behavioral therapy for smoking cessation. All participants are given an 8-week program of smoking cessation classes, and are randomized to either twice weekly yoga (Yoga) or twice-weekly health and wellness classes which serve as a control for contact and participant burden (CTL). Assessments are conducted at baseline, 8 weeks, 3, 6, and 12 months of follow-up. The primary outcome is prolonged abstinence using an intention-to-treat approach. Multiple internal and external audits using blind data collection are employed to ensure treatment fidelity and reliability of study results. To understand why yoga may be more effective than CTL, we will examine the mechanisms of action (i.e., mediators) underlying intervention efficacy. We will examine the maintenance of yoga practice and smoking status at each follow-up. Focus groups and interviews will be used to enrich our understanding of the relationship of yoga practice and smoking abstinence. CONCLUSIONS This study will provide a stringent test of the relative efficacy of yoga compared to a condition that controls for contact time and attention. The use of mixed methodology also provides the opportunity to validate existing knowledge about yoga and helps to explore new themes for future mindfulness and yoga research.
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Affiliation(s)
- Beth C Bock
- Alpert Medical School of Brown University, The Miriam Hospital, 167 Point Street, Providence, RI 02903, USA.
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Behavioral and Social Sciences, School of Public Health, Brown University, 167 Point Street, Providence, RI 02903, USA.
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 167 Point Street, Providence, RI 02903, USA.
| | - Ronnesia B Gaskins
- University of Massachusetts Medical School, School of Public Health, Brown University, 55 Lake Avenue N., Worcester, MA 01655, USA.
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School of Brown University, 167 Point Street, Providence, RI 02903, USA.
| | - Herpreet Thind
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School of Brown University, 167 Point Street, Providence, RI 02903, USA.
| | - James Carmody
- University of Massachusetts Medical School, 55N. Lake Avenue, Worcester, MA 01655, USA.
| | - Shira I Dunsiger
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Department of Behavioral and Social Sciences, School of Public Health, Brown University, 167 Point Street, Providence, RI 02903, USA.
| | - Naama Gidron
- The Motion Center, 111 Chestnut Street, Providence, RI 02903, USA.
| | - Bruce M Becker
- Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
| | - Bess H Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
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Leahey TM, Thomas G, Fava JL, Subak LL, Schembri M, Krupel K, Kumar R, Weinberg B, Wing RR. Adding evidence-based behavioral weight loss strategies to a statewide wellness campaign: a randomized clinical trial. Am J Public Health 2014; 104:1300-6. [PMID: 24832424 DOI: 10.2105/ajph.2014.301870] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign. METHODS We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m(2); 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program. RESULTS Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114). CONCLUSIONS Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses.
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Affiliation(s)
- Tricia M Leahey
- Tricia M. Leahey, Graham Thomas, and Rena R. Wing are with Alpert Medical School of Brown University Department of Psychiatry and Human Behavior, The Miriam Hospital's Weight Control and Diabetes Research Center, Providence, RI. Joseph L. Fava and Katie Krupel are with The Miriam Hospital's Weight Control and Diabetes Research Center, Providence. Leslee L. Subak is with the University of California San Francisco, Department of Obstetrics, Gynecology, and Reproductive Science, San Francisco, CA. Michael Schembri is with University of California San Francisco, Women's Health Clinical Research Center, San Francisco. Rajiv Kumar is with ShapeUp Inc, Providence. Brad Weinberg is with Blueprint Health Inc, New York, NY
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Morrow KM, Fava JL, Rosen RK, Vargas S, Shaw JG, Kojic EM, Kiser PF, Friend DR, Katz, and The Project LINK Study Te DF. Designing preclinical perceptibility measures to evaluate topical vaginal gel formulations: relating user sensory perceptions and experiences to formulation properties. AIDS Res Hum Retroviruses 2014; 30:78-91. [PMID: 24180360 DOI: 10.1089/aid.2013.0099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract The effectiveness of any biomedical prevention technology relies on both biological efficacy and behavioral adherence. Microbicide trials have been hampered by low adherence, limiting the ability to draw meaningful conclusions about product effectiveness. Central to this problem may be an inadequate conceptualization of how product properties themselves impact user experience and adherence. Our goal is to expand the current microbicide development framework to include product "perceptibility," the objective measurement of user sensory perceptions (i.e., sensations) and experiences of formulation performance during use. For vaginal gels, a set of biophysical properties, including rheological properties and measures of spreading and retention, may critically impact user experiences. Project LINK sought to characterize the user experience in this regard, and to validate measures of user sensory perceptions and experiences (USPEs) using four prototype topical vaginal gel formulations designed for pericoital use. Perceptibility scales captured a range of USPEs during the product application process (five scales), ambulation after product insertion (six scales), and during sexual activity (eight scales). Comparative statistical analyses provided empirical support for hypothesized relationships between gel properties, spreading performance, and the user experience. Project LINK provides preliminary evidence for the utility of evaluating USPEs, introducing a paradigm shift in the field of microbicide formulation design. We propose that these user sensory perceptions and experiences initiate cognitive processes in users resulting in product choice and willingness-to-use. By understanding the impact of USPEs on that process, formulation development can optimize both drug delivery and adherence.
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Affiliation(s)
- Kathleen M. Morrow
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joseph L. Fava
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Rochelle K. Rosen
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sara Vargas
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Julia G. Shaw
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - E. Milu Kojic
- Immunology Center, The Miriam Hospital, Providence, Rhode Island
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Patrick F. Kiser
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
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Pinto AM, Fava JL, Raynor HA, LaRose JG, Wing RR. Development and validation of the weight control strategies scale. Obesity (Silver Spring) 2013; 21:2429-36. [PMID: 23512914 PMCID: PMC3778038 DOI: 10.1002/oby.20368] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 12/23/2012] [Accepted: 01/06/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To develop and validate the Weight Control Strategies Scale (WCSS), a self-report instrument to assess the use of specific behaviors thought to facilitate weight loss. DESIGN AND METHODS Factor analysis was conducted on 323 overweight and obese adults (mean age = 48.7 ± 10.9 years, mean body mass index = 35.4 ± 4.9 kg/m(2) , 74% female) enrolled in three different behavioral weight loss trials who completed the WCSS prior to starting treatment. To evaluate construct validity, additional data on dietary intake, physical activity, treatment session attendance, and weight change were obtained from a subsample of participants before and after participation in a 48-week weight loss program. RESULTS Principal components analysis with varimax rotation revealed a four-component solution for the WCSS, representing the following subscales: Dietary Choices, Self-monitoring Strategies, Physical Activity, and Psychological Coping (α from 0.79 to 0.89). Longitudinal analyses showed that WCSS subscale scores increased during treatment (P < 0.01). In adjusted models, changes in WCSS total and subscale scores were associated with post-treatment weight loss (P < 0.01). Additionally, changes in WCSS Dietary Choices and Physical Activity subscales were related to post-treatment changes in total daily kilocalorie consumption (P = 0.019) and weekly kilocalorie expenditure through physical activity (P < 0.001), respectively. CONCLUSIONS Findings support the validity and reliability of the WCSS in a weight loss treatment-seeking sample.
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Affiliation(s)
| | | | | | - Jessica Gokee LaRose
- Warren Alpert Medical School at Brown University, Department Psychiatry and Human Behavior, Providence RI
| | - Rena R. Wing
- Warren Alpert Medical School at Brown University, Department Psychiatry and Human Behavior, Providence RI
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Hart CN, Carskadon MA, Considine RV, Fava JL, Lawton J, Raynor HA, Jelalian E, Owens J, Wing R. Changes in children's sleep duration on food intake, weight, and leptin. Pediatrics 2013; 132:e1473-80. [PMID: 24190680 DOI: 10.1542/peds.2013-1274] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the effect of experimental changes in children's sleep duration on self-reported food intake, food reinforcement, appetite-regulating hormones, and measured weight. METHODS Using a within-subjects, counterbalanced, crossover design, 37 children, 8 to 11 years of age (27% overweight/obese) completed a 3-week study. Children slept their typical amount at home for 1 week and were then randomized to either increase or decrease their time in bed by 1.5 hours per night for 1 week, completing the alternate schedule on the third week. Primary outcomes were dietary intake as assessed by 24-hour dietary recalls, food reinforcement (ie, points earned for a food reward), and fasting leptin and ghrelin. The secondary outcome was child weight. RESULTS Participants achieved a 2 hour, 21 minute difference in the actigraph defined sleep period time between the increase and decrease sleep conditions (P < .001). Compared with the decrease sleep condition, during the increase condition, children reported consuming an average of 134 kcal/day less (P < .05), and exhibited lower fasting morning leptin values (P < .05). Measured weights were 0.22 kg lower during the increase sleep than the decrease sleep condition (P < .001). There were no differences in food reinforcement or in fasting ghrelin. CONCLUSIONS Compared with decreased sleep, increased sleep duration in school-age children resulted in lower reported food intake, lower fasting leptin levels, and lower weight. The potential role of sleep duration in pediatric obesity prevention and treatment warrants further study.
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Affiliation(s)
- Chantelle N Hart
- Center for Obesity Research and Education, Temple University, 3223 N Broad St, Suite 175, Philadelphia, PA 19140.
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LaRose JG, Fava JL, Steeves EA, Hecht J, Wing RR, Raynor HA. Daily self-weighing within a lifestyle intervention: impact on disordered eating symptoms. Health Psychol 2013; 33:297-300. [PMID: 24245845 DOI: 10.1037/a0034218] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether daily self-weighing (DSW) is associated with disordered eating (DE) symptoms within an adult lifestyle intervention (LI), and to examine changes in DE symptoms during the 18-month trial. METHOD One-hundred and seventy-eight adults (53% female, 90% White, 52.0 ± 8.6 years, BMI = 35.0 ± 4.4 kg/m2) were enrolled in a randomized trial testing 2 dietary prescriptions within a LI (standard vs. limited dietary variety). Both arms were taught DSW and had the same contact schedule and calorie and activity goals. Frequency of weighing and DE were assessed at 0, 6, 12, and 18 months. Analyses controlled for treatment arm. RESULTS At baseline, 16.3% of participants reported weighing ≥ daily compared with 83.7%, 72.3%, and 68.2% at 6, 12, and 18 months, respectively. There was no relationship between change in frequency of self-weighing and change in DE symptoms at any time point. Further, there were no significant differences between those who weighed ≥ daily versus < daily on DE composite scores at baseline or 6 months; at 12 and 18 months participants who weighed ≥ daily reported lower DE scores compared with those who weighed < daily (p = .008 and .043 at 12 and 18 months, respectively). Participants who weighed ≥ daily achieved better weight losses than those weighing < daily at 12 and 18 months (p = .003 and <.001). There was a significant reduction over time in DE symptoms (p < .0001) and a reduction in odds of meeting criteria for Binge Eating Disorder (BED; ps < .001). CONCLUSIONS Daily self-weighing did not appear to be related to increased disordered eating behavior and was associated with better weight loss outcomes.
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Affiliation(s)
- Jessica Gokee LaRose
- Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, The Miriam Hospital
| | - Joseph L Fava
- Weight Control and Diabetes Research Center, The Miriam Hospital
| | | | - Jacki Hecht
- Weight Control and Diabetes Research Center, The Miriam Hospital
| | - Rena R Wing
- Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, The Miriam Hospital
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Abstract
Young adults (YA) are at high risk for insufficient sleep and obesity. However, little research has focused on the association between sleep and obesity in this population. The present study examined the association between reported time in bed (TIB) and body mass index (BMI) in YAs. Participants were 250 18-25 year-olds who completed an online survey assessing several factors associated with weight control. After controlling for significant covariates, TIB was significantly associated with BMI. Specifically, "less than 6 hours/night" TIB was associated with increased BMI compared to the referent category (7 to <8 hours/night) (p = .01). Findings demonstrate that young adults who report shorter TIB are more likely to be classified as having higher BMI.
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Affiliation(s)
- Chantelle N. Hart
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903
| | - Jessica Gokee LaRose
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903
| | - Joseph L. Fava
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903
| | - Brittany James
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903
| | - Rena R. Wing
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 196 Richmond Street, Providence, RI 02903
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Shuhaiber JH, Fava JL, Shin T, Dobrilovic N, Ehsan A, Bert A, Sellke F. The influence of seasons and lunar cycle on hospital outcomes following ascending aortic dissection repair. Interact Cardiovasc Thorac Surg 2013; 17:818-22. [PMID: 23838340 PMCID: PMC3805194 DOI: 10.1093/icvts/ivt299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 05/27/2013] [Accepted: 06/13/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The effect of the lunar cycle and seasonal variation on ascending aortic dissection surgery outcomes is unknown. We investigated these temporal effects on risk-adjusted hospital mortality and then on the length of stay (LOS) following surgery for survivors. METHODS We examined prospectively collected data from cardiac operations at two major centres within a single state between January 1996 and December 2011. We first examined the relationship between the lunar cycle and seasonal variation, along with demographic and risk profile covariates, with mortality using univariate analyses, followed by multiple logistic regression modelling that controlled for demographic and patient risk variables including age, gender, risk profile (diabetes, hypertension, dyslipidaemia and renal failure), and two surgical groups: Group A, consisting of patients having repair of ascending aorta dissection repair only, and Group B, with those having ascending aorta repair plus aortic valve surgery or coronary bypass surgery or both. We further examined the relationship with LOS using both univariate and multiple regression analyses. RESULTS There were 210 patients who had repair of dissection in the study period, with 109 patients in Group A and 101 in Group B. The average age of this sample was 59.5 (standard deviation = 16.0), 65.7% were male and 18.1% died prior to discharge following repair. The greatest percentage of deaths occurred in winter (31.6%, n = 12), while the least were in summer (21.1%, n = 8) and fall (21.1%, n = 8). An overall χ(2) test found there was no difference in mortality for season (P = 0.55). Univariate analyses also found the age of patients who died vs lived was significantly higher (65.9 vs 58.1 years; P = 0.001), and a significantly greater (P = 0.029) percentage of patients with diabetes vs without diabetes died (41.7 vs 16.7%). Univariate analyses found all other covariates were not significantly related to mortality. In the multiple logistic regression model, there was no significant effect for season, while the odds of dying increased with age (odds ratio [OR] = 1.04, 95% confidence interval [95% CI] = 1.01-1.07, P = 0.012), and the odds of dying in the full-moon cycle vs the new moon cycle was significantly reduced (OR = 0.21, 95% CI = 0.05-0.81, P = 0.024). No other covariate significantly increased or decreased the odds of death, including diabetes risk, which had been significantly related to death in the univariate analysis. Within a linear regression model that examined the relationship with LOS, Group B (P = 0.020), male sex (P = 0.036) and the full-moon lunar phase (P = 0.001) were significantly related to shorter LOS. CONCLUSIONS Season had no effect on mortality or LOS following aortic dissection repair, while patient age significantly increased the odds of death. The full-moon cycle appeared to reduce the odds of death, and the full-moon cycle, along with being male and requiring a concomitant cardiac procedure, was associated with shorter LOS.
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Affiliation(s)
- Jeffrey H. Shuhaiber
- Centers for Behavioral and Preventive Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Critical Care and Anesthesia, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Cardiothoracic Surgery, Rhode Island Hospital, Hasbro Children Hospital, Brown Medical School, Providence, RI, USA
| | - Joseph L. Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Tai Shin
- Centers for Behavioral and Preventive Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Critical Care and Anesthesia, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Nikola Dobrilovic
- Centers for Behavioral and Preventive Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Critical Care and Anesthesia, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Afshin Ehsan
- Centers for Behavioral and Preventive Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Critical Care and Anesthesia, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Arthur Bert
- Centers for Behavioral and Preventive Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Critical Care and Anesthesia, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Frank Sellke
- Centers for Behavioral and Preventive Medicine, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Critical Care and Anesthesia, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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